Purpose: To determine the prevalence of and the risk factors for Helicobacter pylori (H. pylori ) in internationally adopted children

Nutrition-Related Measures:

Physical growth: standard anthropometry [height, weight, head circumference (OFC)]. Z scores for height and weight were calculated using the World Health Organization standards and for OFC using data from American children because the World Health Organization did not have published standards for OFC at the time.

Anemia: complete blood cell count

Diarrhea: Parent-report

Intestinal Parasites: stool examination for ova and parasites and serology (the presence of antibodies) for H. pylori

Participants: 226 international adoptees between the ages of 4 months and 16 years at adoption. Children were adopted from 18 countries. The majority (70%) came from Russia, Romania, or China. Of those with pre-adoption information, 66% were institutionalized since birth, 12% lived in foster care, and the remaining children lived in a variety of settings prior to adoption

Methods: Chart review of routine medical evaluations completed at one international adoption clinic soon after arrival into the U. S. All children who had routine laboratory testing completed at one international adoption during a two-year period were included.

Nutrition Results:

Anemia: 17% had anemia (hematocrit <30%).

Diarrhea: 18% had diarrhea during the first few weeks after arrival.

Intestinal Parasites: 27% had intestinal parasites

Infection with intestinal parasites was associated with longer duration of institutionalization.

Giardia lamblia was the most common.

Parasites were found in children from most countries. 27% of children from Russia had intestinal parasites, 8% from Romania, and 7% from China.

31% were positive for H. pylori antibodies

49% of children from Russia had positive results forH. pylori , 20% from Romania, and 16% from China.

H. pylori- positive was associated with older age at arrival, living in institutional care (rather than foster care; no children living in foster care were positive).

There was no difference in physical growth measures between those positive and those negative for H. pylori .

There was a greater prevalence other parasite infections in those tested positive for H. pylori (H. pylori positive: 44%; H. pylori negative: 19%)

There was no difference in the prevalence of anemia or diarrhea between those infected with H. pylori and those without .

Conclusions & Clinical Implications: Nearly one-third (31%) of the international adoptees were H. pylori -positive. H. pylori was associated with being in institutional care, older age at adoption, and infections with other intestinal parasites. Previous studies in other populations of children have reported an increase in malnutrition, including anemia, diarrhea, and growth failure, in those with H. pylori or other parasitic infections. However, there were no such associations between H. pylori or other parasitic infections and malnutrition in this sample of international adoptees. The authors suggest that these associations were not found because H. pylori infection is just one of the many risk factors for malnutrition in international adoptees.

Limitations of the Nutritional Results: The only marker used to identify anemia was hematocrit, and it was not reported whether the anemia was due to iron deficiency or another etiology.